Social Care

Baroness Pitkeathley Excerpts

Thursday 29th November 2012 Lords Chamber

Moved By

[Baroness Pitkeathley]

That this House takes note of the impact of changes in local authority budgets on the provision of social care and its integration with other health, housing and care services.

[Baroness Pitkeathley]

Well, my Lords, here we are again. It is almost exactly a year since I last introduced a debate on social care, and once again I feel like Captain Renault in my favourite film, “Casablanca”, rounding up the usual suspects. Noble Lords speaking today are once again those with form on this issue, although I am pleased to say that we have some new recruits to our numbers as well.

Last year’s debate focused on the report of the Dilnot commission, and it is a matter of great regret to me—and to many others, I am sure—that, in spite of general agreement around the House at that time that doing nothing was not an option, still no decision has been taken about these important proposals. Andrew Dilnot and his colleagues continue to press the issue with hope and enthusiasm, and we hear lots of rumours that we may have an announcement in the Autumn Budget Statement, next spring, next Budget or in the next spending review—but still no actual commitment.

In his response to the debate last year, the Minister said that we have an opportunity to get this right and we must not miss it. No one could possibly disagree with that but I must begin this debate by recording my intense disappointment that, one year on, we are no further ahead with implementing a long-term solution to the problems of social care.

However, we are focusing today on the immediate problems faced by local authorities and the impact of those on the rest of the system. When we discuss integration, as we often have during the past year, we usually focus on the particular interface between health and social care services. The topic of this debate is deliberately wider, though, acknowledging that care needs do not come in discrete packages but are stretched across the whole of an elderly or disabled person’s life, including their housing, their families and their income.

We must acknowledge that we are not in exactly the same place that we were last year. The Health and Social Care Bill that we were debating then is now an Act, and many promises were made about how it would make integration between health and social care easier. It perhaps is too early to say whether this is becoming a universal reality but none of the reports coming out of local authorities and the NHS fill one with hope. In a recent survey by the NHS Confederation, for example, 66% of NHS leaders said that shortfalls in local authority spending had impacted on their services last year. Delayed transfers of care cost the NHS about £200 million a year, and the human distress that such delays cause to patients and families is incalculable.

I know that the Minister will remind us that in last year’s CSR the Government transferred an extra £2 billion to social care by 2015, £1 billion of that coming from the NHS. Local authorities were grateful for that, of course, although it has been called a sticking-plaster solution. Even if it were to be allocated on a permanent basis, £2 billion is not nearly adequate to meet the needs of the social care system. While the transfer of funds from the NHS to social care has been crucial, not all areas have been able to use the money in the way intended—for example, on hospital discharge, reablement and intermediate care. These have made a difference in some areas but too often they paper over cracks in a system that is groaning and only storing up more problems for the future.

In summary—I will say this briefly since I know that the usual suspects are only too familiar with it—the system is not fit for purpose and we spend inadequate amounts on care and support both publicly and privately. Social care funding has totally failed to keep pace with demographic change. Since 2004, while spending in the NHS has risen by £25 billion, spending on social care has risen by just £43 million.

I am always aware of saying how inadequate our care provision is, lest it be seen as criticism of the many dedicated people who work in the system providing care and sometimes pushing the boundaries to focus on prevention and innovative ways of meeting need. We cannot avoid recognising that the way in which local authorities have dealt with the fact that need has far outstretched funding has been to increase charges and rapidly to raise the threshold at which you can qualify for care. You get care only if your needs are seen as substantial or critical.

In too many areas, services are provided only to those whose care needs are the most severe. The LGA has stated that it expects a funding gap for local authority services of £16.5 billion a year by 2019, or a 29% shortfall, between revenue and spending pressures. It further estimates that in the not-too-distant future, social care and waste spending together will absorb such a huge percentage of their funding that other services will have to take an 80% cut.

Without action on funding and integration, even very basic care—those basic 15 minutes a day, which is all that many elderly and disabled people can expect—will not be available in future. Only this week, the weather sees us having to factor into local authority budgets the huge extra costs that many of them will have as a result of the floods. Not only is this level of care completely inadequate but the fact that it is provided only to those with severe or critical needs makes a nonsense of the prevention that all sides say is the key to ensuring that care needs do not escalate to crisis point.

Moreover, this takes no account at all of the many people who currently meet their own care needs in full. Not only may they have to use local authority services in future but no attempt to preserve the quality of the services can be made for those people. Mencap provides clear evidence that local authorities are struggling with reduced funding from central government and increased demand for services. Over the past three years, one in three local authorities has closed day services and 57% of people with a learning disability no longer receive any day-service provision. Carers UK reports that carers are being affected by the closure of council-run services and by the cuts to grants to the voluntary sector, which provides vital services locally. One carer said that getting respite care service nowadays is like getting blood out of a stone.

When people’s care needs are not met by social care systems, what happens? They turn, of course, to the NHS. This results in increased demand for unplanned and emergency services and delays in hospital discharge. In addition, 88% of GPs surveyed recently by Carers UK report that their patients are being put at risk due to a lack of social care support.

These extra pressures come at a time when the NHS is already under severe financial pressure. The CSR protected NHS funding to some degree but did not take account of rising demand and rapidly increasing healthcare costs. We all know that the NHS is expected to make £20 billion of savings and efficiencies by 2014-15, and the recent report from the CQC paints a sad picture of how cost-cutting is being put ahead of patient welfare, with 16% of hospitals surveyed not meeting the CQC standards for having enough staff on duty to care properly for patients, and warns that this may lead to a culture in which unacceptable standards of care become the norm. Yesterday’s report from the King’s Fund paints a similar picture for the NHS of bed closures, lost services and low morale.

No one could possibly disagree that the NHS and all care services must be run as efficiently as possible. One of the most important ways in which to make efficiencies in either health or social care is through integrating services, an issue that we have debated many times in your Lordships’ House. The money transferred to local authorities from the NHS has helped to stimulate integration and certainly to develop interest in it, but evidence given by the King’s Fund to the Health Select Committee notes that a lack of urgency in delivering integrated care remains and, indeed, that the huge upheaval that we have seen in the NHS since last year has hampered progress and resulted in lost momentum. In this context, it was a positive step to see a paragraph in the recently published mandate emphasise the role of the Commissioning Board in driving and co-ordinating engagement with local councils. For the sake of the increasing numbers of people in urgent need of co-ordinated services, we must hope that the mandate delivers.

The other significant development since last year is, of course, the draft Care and Support Bill. I am honoured to be a member, along with my noble friend Lord Warner, of the pre-legislative scrutiny committee considering this. We shall spend many happy hours with colleagues from this House and another place hearing evidence, testing proposals and debating provisions. There is not time to go into the detail of that Bill here, save to say that there are many welcome proposals in it, and the Government are to be congratulated on an excellent attempt to achieve co-ordination of the many disparate strands of care legislation and to give greater recognition and more rights to users and carers.

In terms of the issue that we are debating today, it is hard to feel anything but anxiety about the extra duties placed on local authorities and on how on earth they are to be funded. Do not mistake me—I could not be more delighted that support for carers will be strengthened or that there will be an obligation on local authorities to provide information and advice to promote diversity and quality, or with the references to assessments and care and support plans, as well as a very much to be praised reference to national eligibility criteria. But even those far-reaching reforms could be viewed as a sticking-plaster solution if we do not tackle the fundamental problem of how social care is funded. The inconsistency between fully funded NHS care and means-tested social care not only confuses users and carers but inevitably hampers the delivery of a comprehensive care package.

Noble Lords may have noticed thus far my subtle references to a need for more money in the system. In conclusion, I want to focus on money. I know that the Government’s response to calls for more money in the system is always, understandably, “There is no more money”. As Andrew Dilnot frequently says, though, it is a question not of “can’t afford it” but of “won’t afford it”. Our GDP shows that we are five times better off than we were in 1948. Time and again, we find that social care properly delivered, of good reliable quality and with an emphasis on preventive care is a better way of caring for older and disabled people than healthcare, especially in a hospital bed, could ever be. If we pool the risk—after all, only one in five of us will ever need high levels of social care—and give it the priority that it deserves, we can afford it. It is a matter of priorities. We can easily find several billion pounds by stopping tax avoidance if we really put our minds to it.

We need to start thinking long-term about the real costs of failures in social care and think more broadly about what those failures will mean to the economy as a whole. I shall give an example. Diminishing social care from councils has hit business productivity. As fewer older and disabled people are able to access social care services, growing numbers of family members are being forced to give up work to care for their loved ones. An estimated 1 million people have given up paid work or reduced their working hours to care for their loved ones. The LSE tells us that the public expenditure cost of families giving up work is £1.3 billion a year in additional expenditure on carers’ benefits and lost tax revenues. If lost earnings are taken into account, the figure rises to £5.3 billion. These are the sort of long-term effects of the current shortages in funding that we should be considering.

I know, as do all noble Lords, that the Minister cannot make a commitment here today to put more much needed money into the system. However, I know him to be a man of commitment and vision, as well as a very busy one today—I also know that the whole House will be delighted with the award that he received last night—and I ask that he commits to taking the message from your Lordships’ House back to his department and to the coalition Government and tries to persuade colleagues to see that investing properly in social care is just that—an investment, not a drain. It saves costs down the line, assuages one of the worst worries of citizens and will earn the thanks of the nation, both those in need of care at present and all of us who may need it in future.

As for the argument that says that times are hard and this is not the time to enter into major extra commitments, I remind your Lordships that the Beveridge report of 70 years ago was published and accepted in the middle of a world war, yet our forebears had no problem with the vision and commitment to take on those far-reaching changes even though the country was, in the words of one noble Lord in this House this week, absolutely skint. We are not skint. We live in a time of relative peace and prosperity. Should we not be prepared to follow in the footsteps of those courageous forebears? I beg to move.

--- Later in debate ---

[Baroness Pitkeathley]

My Lords, it is a comfort to me that the number of usual suspects swelled gratifyingly for this debate—a sign, perhaps, that we are getting nearer to understanding that this is the pre-eminent social issue of our times, in terms of both the current gap and the need for long-term solutions.

We have had a wide-ranging debate and a powerful set of speeches. There is agreement that there is a crisis—or rather a series of crises, in the short, medium and long term—and suggestions for how to tackle those. We have had ideas and examples focusing on innovation, integration, efficiency, and we have even had ideas about how we can get more money into the system. We also have agreement about the urgency of the need and about the importance of that old chestnut for many of us, integrated care.

The Minister has given us his usual thoughtful response, for which I thank him, and we all know his sincere commitment to finding a solution to the problem of social care, although I find it hard to recognise the picture of local services he paints from the ones presented to me. I shall take pleasure in checking this out with the group of 200 carers whom I am addressing tomorrow at a carers’ rights day. I shall ask them for their opinion of the situation.

I return to my original thought—which others have echoed, including the Minister—that social care should be seen as an investment, as a way of saving money, especially for the NHS. But this needs much more sharing of money and much less silo thinking, and more focus on the consequences of not doing it rather than on the cost of doing it. For example, if we just take Dilnot—and I am grateful for the calls from many Peers for Dilnot to be implemented—we know that the cost of implementation is about £2 billion. It is not the whole solution, as many noble Lords have said, but no one has yet found a better place to start. To set that £2 billion in context, family carers are contributing care worth at least £119 billion a year. If only 10% of them give up because they are too exhausted, stressed and poor to continue, that will cost £12 billion—six times the cost of Dilnot. Can we not afford to make the investment that local authorities, the NHS and, above all, the users and carers deserve?

The issue of social care needs radical thought and change, and leadership at national level. As has been said, the inexorable arithmetic of the demographics means that we cannot ignore it and put it into the “too difficult” box, however tempting that may be. Without tackling the resource issue, things will only get worse. Will we be here again next year, reporting on how the situation has deteriorated further? I sincerely hope not. I thank all noble Lords who have spoken, and beg to move.

Motion agreed.